瘢痕妊娠产妇行剖宫产终止妊娠术中出血量的影响因素分析

Analysis on the related influencing factors of the amount of hemorrhage during cesarean section and termination of pregnancy for the pregnant women with cicatricial pregnancy

目的分析瘢痕妊娠产妇行剖宫产终止妊娠术中出血量的相关影响因素,降低产妇术中出血量,改善妊娠结果。方法选取2017年3月-2019年10月义乌天祥医疗东方医院收治的159例瘢痕妊娠产妇为研究对象,所有研究对象均选择剖宫产手术终止妊娠,均顺利娩出胎儿。将研究对象分为术中出血量≥200 ml组(45例)和出血量<200 ml(114例)组进行影响因素分析,影响因素包括合并疾病、宫缩乏力、盆腔粘连、软产道损伤、胎盘因素、ASA分级、剖宫产次数、孕周、妊娠次数、流产史、距离上次剖宫产时间、麻醉方式、胎盘附着位置、胎盘脐带绕颈及子宫切口等,应用秩和检验和多因素Logistic回归分析术中出血量≥200 ml的危险因素。结果单因素分析结果显示,瘢痕妊娠产妇行剖宫产终止妊娠术中出血量与全麻、合并疾病、宫缩乏力、盆腔粘连、胎盘因素及子宫切口有关(P=0.004、0.000、0.000、0.000、0.011及0.013),而与胎盘附着位置、剖宫产次数、孕周、妊娠次数、流产史、距离上次剖宫产时间、ASA分级、软产道损伤及胎盘脐带绕颈无关(均P>0.05)。非条件Logistic回归分析结果显示,全麻、宫缩乏力、盆腔粘连、胎盘因素及子宫切口是瘢痕妊娠产妇行剖宫产终止妊娠术中出血量的独立危险因素(P=0.021、0.000、0.004、0.000及0.016,OR=3.578、4.243、5.141、3.875及4.673),而合并疾病则非独立危险因素(P>0.05)。结论瘢痕妊娠产妇行剖宫产终止妊娠术中出血量的独立危险因素包括全麻、宫缩乏力、盆腔粘连、胎盘因素及子宫切口,临床上应尽早选择合适麻醉方式,并做好围术期准备,使用缩宫素以减少剖宫产术中出血量。

Objective To analyze the related influencing factors of the amount of hemorrhage during caesarean section in the pregnant women with cicatricial pregnancy,reduce the amout of hemorrhage during cesarean section,and improve pregnancy outcome.Methods A total of 159 women with cicatricial pregnancy admitted to Yiwu Tianxiang Medical Eastern Hospital from March 2017 to October 2019 were selected as the study subjects.All the study subjects terminated pregnancy by cesarean section,and the fetuses were delivered successfully.The study subjects were divided into intraoperative blood loss≥200 ml grou p(45 cases)and intraoperative blood loss<200 ml group(114 cases)for influencing factors analysis.The influencing factors included complications,uterine weakness,pelvic adhesion,soft birth canal injury,placental factors,ASA classification,the times of cesarean section,gestational age,the times of pregnancy,abortion history,the time since last cesarean section,anesthesia method,placental attachment position,placental umbilical cord around neck,and uterine incision.The risk factors of intraoperative blood loss≥200 ml were analyzed by rank sum test and multivariate Logistic regression analysis.Results The results of univariate analysis showed that the amount of hemorrhage during cesarean section was related to general anesthesia,complicated diseases,uterine weakness,pelvic adhesion,placental factors,and uterine incision,respectively(P=0.004,0.000,0.000,0.000,0.011,0.013,respectively),while placental attachment position,the times of cesarean section,pregnancy weeks,pregnancy times,abortion history,the time from last cesarean section,ASA score grade,laceration of soft birth canal,and cord around neck were not related to the amount of hemorrhage during cesarean section(all P>0.05).Unconditional logistic regression analysis showed that general anesthesia,uterine atony,pelvic adhesion,placental factors,and uterine incision were the independent risk factors of the amount of hemorrhage during cesarean section(P=0.021,0.000,0.004,0.000,0.016,respectively;OR=3.578,4.243,5.141,3.875,4.673,respectively),while the combined diseases were not the independent risk factors of the amount of hemorrhage during cesarean section(P>0.05).Conclusion The independent risk factors of the amount of hemorrhage during cesarean section include general anesthesia,uterine atony,pelvic adhesion,placenta factor,and uterine incision.In clinical practice,it is necessary to select the appropriate anesthesia mode as early as possible,and make pre-operation preparation,avoid the original scar uterine incision,and use oxytocin to reduce the amount of hemorrhage during cesarean section.